The
authors are from the Department of Pulmonary, Critical Care and Sleep Medicine
at the University of Florida (Gainesville, FL) and the Department of Pulmonary
and Critical Care Medicine of Saint Joseph Heart and Lung Institute (Phoenix,
AZ).

I am neither a pathologist nor a medical doctor of any kind, so I won’t go into detail
about the pathology other than some general documented findings the authors
observed.

This
case is of a 44 year old woman who is an
ex-smoker (quit 10 years ago), but currently uses cocaine and cannabis. She has
HIV and has had past mycobacterial and pneumocystis infections. The woman presented
to hospital with subacute fever (5 day duration). She had a cough with productive
yellow sputum, which eventually developed into a dry cough. Chest x-ray was
suggestive of pneumonia. According to the authors the patient’s clinical,
radiographic, and histopathology “was consistent with respiratory
bronchiolitis-associated interstitial lung disease (RB-ILD). Bronchoalveolar
lavage fluid was colored black.

Interestingly, in
the "Learning Points" section, the authors state:

Pulmonary
complications may result from impurities inhaled during the process of cocaine
smoking. We propose that synthetic cannabinoids can do the same by a similar
mechanism.

Other
than the title of the paper, this is the only time “synthetic cannabinoids” are
mentioned.

What
am I missing here? How are synthetic cannabinoids involved in this case report?
I’m confused. The title of this case
report is "Synthetic cannabinoids as a cause...". That leads one to believe that synthetic cannabinoids or use of associated
products were involved in some fashion, but I’m not sure where they actually
fit it other than a possible undiscussed hypothesis from the authors. Synthetic cannabinoids aren't even mentioned at at all in the patient's history, so why throw that hypothesis out there?!?